Prognosis of drug-related hospital admissions in older adults in an acute-care geriatric unit: a prospective cohort study.

OBJECTIVES: Drug-related hospital admissions (DRAs) are prevalent among older adults, with a substantial proportion deemed preventable. Despite their frequency, little is known about the prognosis of DRAs in this population, particularly concerning mortality and hospital readmissions. The objectives were to assess the prognosis of DRAs in older patients, focusing on 6-month mortality and unplanned readmissions. DESIGN: Prospective cohort study. SETTING: A 20-bed acute-care geriatric unit within an academic hospital. PARTICIPANTS: All patients aged 75 years or older hospitalised in the unit during 2023. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was 6-month all-cause mortality. The secondary outcome was the rate of unplanned hospital readmissions, including emergency department visits, within 6 months. DRAs were identified using a two-step standardised review process. Kaplan-Meier survival curves and Cox proportional hazards models were used to estimate hazard ratios (HRs) for mortality. Fine and Grey competing risk models were applied for the analysis of unplanned readmissions. Multivariable models adjusted for age, sex, Charlson Comorbidity Index, medication count, activities of daily living score, long-term care residency and prior hospitalisations. RESULTS: Among 483 patients included (median age 86 years [IQR 81-91]), 207 (43%) were admitted for a DRA. At 6 months, mortality was significantly lower in patients with DRAs compared with those without (19% [n=39] vs 37% [n=102]; p<0.001), a finding that remained robust after adjustment for confounders (adjusted HR 0.46; 95% CI 0.30 to 0.67; p<0.001). Unplanned readmission rates were comparable between groups. CONCLUSIONS: DRAs have a distinct prognosis as compared with other causes of admission among older patients. Identifying and managing DRAs are crucial for minimising preventable complications in this vulnerable population.